Alors que le suicide est dépénalisé depuis plus de deux siècles dans nos pays, inciter une personne à se supprimer ou y contribuer activement est d'ordinaire puni par la loi et réprouvé par l'éthique. Démêler ce paradoxe et rendre plus intelligible un acte qui ne le sera peut-être jamais est le but de cet ouvrage. Qu'en ont dit les grands penseurs, des stoïciens jusqu'à saint Augustin, Thomas d'Aquin, Hume, Kant ou Emile Durkheim ? Et aujourd'hui, que peuvent nous apprendre le psychiatre et le travailleur social, le théologien et le médecin en soins palliatifs, ou encore l'économiste, qui lève ici le voile sur un tabou occidental ? Car le suicide d'une personne questionne les valeurs sur lesquelles reposent nos démocraties, comme la dignité humaine, la liberté ou la solidarité.
Un livre indispensable à toute discussion raisonnable sur l'euthanasie, l'aide au suicide et la prévention d'actes suicidaires.
OBJECTIVE: Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.
METHOD: We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.
RESULT: A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.
SIGNIFICANCE OF RESULTS: This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.
Le thème de la mort chez les jeunes est l’objet de nombreuses recherches de toutes les disciplines des sciences humaines et sociales. En premier lieu, relevons l’analyse des dimensions touchant le suicide dans cette population. L’étude des représentations sociales entourant le suicide met ainsi en évidence des dimensions socioculturelles pour expliquer sa signification, les facteurs de prévalence, les croyances qui le sous-tendent et leurs liens avec la dimension religieuse (Mereus, 2006). Les données sur les idéations suicidaires et les conduites suicidaires issues de recherches dans plusieurs contextes nationaux démontrent la variabilité des prévalences, des stratégies et des déterminants identitaires, psychologiques et socio-économiques (Peyre et al., 2014; Caron et Robitaille, 2007; Volant, 2006; Belloc, Leichsenring et Chabrol, 2004) et mettent en évidence des enjeux éthiques (Corriveau et al., 2016) tout en soulignant l’importance des campagnes de prévention et des suivis psychologiques.
Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men's overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The "unforeseen suicides" referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, "rationalized suicides" detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause-effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, "managing emotions" whereby participants distanced themselves, but also drew meaning from the suicide.
Head and neck cancer affects vital functions of speech, swallowing, breathing, and appearance. Overall survival remains poor and symptom burden is high for both patients with incurable disease at the end of life and for long-term survivors. Early and concurrent palliative care helps guide treatment decision making and support quality of life during and after treatment. Both narrative competence and directive counsel can affect the concordance of patient goals and tolerance of treatment and outcomes.
This research aimed to explore the role of workplace responses in psychologists’ adaptation to client suicides. Participants were 178 psychologists who completed an online self-report questionnaire which included both open and closed questions yielding qualitative and quantitative data. Fifty-six (31.5%) participants reported one or more client suicides. Mixed results were found in terms of perceived support from the workplace following a client suicide. Psychologists reported a need for more open communication in the workplace, peer supports, space to grieve, as well as opportunities to engage in a learning process. The findings have important implications for research and for understanding the role of the workplace postvention. It also raises the need for external support to be accessible for psychologists working in private practice.
Several reports have indicated that grief and mental health outcomes of people bereaved by suicide vary by their relationship to the deceased. Parents who have lost offspring experience higher levels of distress than those with other relationships to the deceased. However, there are limited studies investigating the experience of parental bereavement by suicide, and further research is needed. The present study aimed to clarify the differences in grief reactions between bereaved parents and those with other relationships to the deceased in Japan and explore a statistical model of adaptation to the loss. In total, 105 bereaved participants completed a questionnaire covering grief reaction, meaning reconstruction, mental health, social context, and demographic variables. Parents scored higher on several grief reaction items and lower in sense-making than those with other relationships. In addition, path analysis showed that sense-making acted as a moderator in the experience of loss of offspring and grief reaction.
This article presents qualitative data to explore the experience of farming family members faced with accidental or suicide death and understand how this is experienced within the farming context. Individual semistructured interviews were conducted with 25 members of Australian farming families bereaved by suicide or accidental death. Qualitative data was thematically analyzed. Three interconnected themes were identified: acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place. Bereavement and reconstruction of meaning following suicide or accidental death for farming families is influenced by the cultural, social, geographical, and psychological contexts of farming families. This article challenges traditional conceptions of suicide and accidental death as necessarily experienced as “violent” or “traumatic,” bereavement as experienced similarly across western cultures, and the reaction to suicide or accidental death as one that challenges people’s understanding of their world and leaves them struggling to find a reason why the death occurred.
Background: Many organizations provide support to people affected by suicide-related behavior, for example, those bereaved by suicide, those who have attempted suicide, and their informal carers. However, evidence regarding how well used, and acceptable, these resources are is lacking. Aims: To investigate the views about and experiences with support and resources of people with lived experience of suicide bereavement, suicide attempt, or caring.
Method: The study was conducted in Queensland, Australia. In total, 175 people completed the survey. Data were analyzed using SPSS Statistics 22.
Results: Participants found resources helpful and user-friendly, but many had never searched for support, did not know it was available, or felt no better after using it. Respondents who had attempted suicide were more likely to look for resources, but less likely to feel better after using them and endorsed more barriers to accessing support.
Limitations: This study used a convenience sample of individuals living in Queensland, was biased toward help-seeking populations, and included mostly women, and therefore it was not representative.
Conclusion: Support and resources that are more flexible and accessible, and are offered in a more proactive manner could improve the user experiences of people affected by suicide-related behavior.
Background: Bereavement is associated with impaired mental health, increases in adverse health behaviors, and heightened risk of suicidal ideation, attempts, and death by suicide. The purpose of this literature review was to explore associations between cause of death and suicidal thoughts among bereaved individuals. Our aim was to compare incidence of suicidal ideation by cause of death and identify gaps in this literature to guide future research and clinical intervention.
Methods: PRISMA-P guidelines were used to structure an electronic literature search in the PsycINFO, MEDLINE, and Web of Science databases. The search focused on English language studies that were published before February 2019 and sought to compare rates of suicidal ideation among bereaved people who lost a loved one to suicide, accidental overdose, cancer, dementia, cardiovascular disease, and HIV/AIDs.
Results: Ten articles were identified with suicide as cause of death, zero articles for accidental overdose, zero articles for cardiovascular disease, eight articles for cancer, one article for dementia, and one article for HIV/AIDs. Given the limited number of articles generated by our search, a formal meta-analysis was not appropriate. However, a comparison of results did suggest that suicide bereavement was associated with the highest rates of suicide ideation (14.1% to 49%). Stigma, isolation, avoidance behaviors, and psychological distress were associated with suicidal thoughts among bereaved individuals, regardless of the deceased's cause of death.
Conclusions: Findings of this literature search revealed significant gaps in the literature, especially regarding thoughts of suicide in bereaved survivors of accidental overdose and cardiovascular disease. Results suggest that multiple causes of death are associated with suicidal ideation in bereavement, but that suicide bereavement may be the cause of death associated with the highest risk of suicidal ideation. More research is needed to understand the ways in which cause of death influences prevalence, risk, and protective factors associated with suicidal thoughts among bereaved individuals.
People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of suicide bereavement on the interpersonal relationships of young adults in the UK using an online survey to collect qualitative data. We conducted thematic analysis of free-text responses from 499 adults to questions capturing the impact of bereavement on relationships with partners, close friends, close family, extended family, and other contacts. We identified four main themes describing the changes in relationships following the suicide: (1) Social discomfort over the death (stigma and taboo; painfulness for self or others to discuss; socially prescribed grief reactions); (2) social withdrawal (loss of social confidence; withdrawal as a coping mechanism); (3) shared bereavement experience creating closeness and avoidance; (4) attachments influenced by fear of further losses (overprotectiveness towards others; avoiding attachments as protective). These findings contribute to understanding deficits in support and pathways to suicidality after suicide bereavement. Such disrupted attachments add to the burden of grief and could be addressed by public education on how to support those bereaved by suicide.
Researchers have yet to explore suicide survivors activities in social organizations, which was the present purpose. I studied an Israeli organization, Path to Life, by interviewing 16 members, attending 11 events, and examining media, online, and print information. Although mainly comprised of activists whose loss occurred in civilian circumstances, frame analysis revealed that the organization emphasizes connections between suicide and esteemed military-related death. By relying on a legitimate model of dealing with death, the activists provided meaning to suicide and promoted a sociocultural change through drawing attention to a silenced death, upgrading the suicide victims' status, and enfranchising survivors' grief.
To explore possible distinctive features of online memorials for youth suicides, amid concerns about glorification, we compared public Facebook memorials for suicides and road traffic accident deaths, using Linguistic Inquiry and Word Count software. People who posted on memorial sites wrote at greater length about suicides, using longer words and more quotation marks. Words suggesting causation and achievement were more prevalent in suicide memorials. Thematic content for the two types of death was more similar than different. Suicide memorial posts had more tentative words, non-fluencies, and question marks, suggesting that people were struggling to make sense of these deaths.
This is a secondary analysis of three qualitative studies about MAiD in which researchers asked about the differences between suicide and MAiD. In all, researchers interviewed 52 Canadians; 7 were people who had requested MAiD and had been found ineligible, 6 were MAiD providers and 39 were socially and economically marginalized. The overwhelming response was that MAiD is better than suicide in the context of suffering at the end of life. Whereas these people perceived suicide as uncertain, difficult, and something that was usually done alone and without support, they thought MAiD was certain, painless, and more socially acceptable.
Efforts to clarify suicide terminology fail to address nuances in suicide-related communication, often relying on poorly-defined terms or implying communication exists primarily as manipulation. In the present paper, we review examples from existing literature and explore how personal suicide-related communication differs from prevention and exposure communication. We also separate definitions for five common types of personal-suicide-related communication: (a) suicide-related disclosure, (b) suicide-related notification, (c) unintended suicide-related communication, (d) coerced suicide-related communication, and (e) conditional suicide-related communication. Finally, we provide specific ways in which standardized definitions can enhance both research and clinical efforts in the future.
The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one's death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal.
Grief, death, bereavement, and loss do not discriminate based on gender identity or sexual orientation. Limited attention has been given to the bereaved partners of transgender and gender non-conforming persons (TGNC). Despite recent efforts to protect the rights of TGNC persons, the death of a TGNC partner is often complicated, marked by family members and friends who might never have known or refused to acknowledge the deceased in his, her, or their preferred gender. The present study adopted a single case study design to examine the death of a TGNC spouse through the unique lens of a bereaved partner.
An advance care directive (ACD) is a written expression of a person's preferences in relation to health care, which can appoint a trusted substitute decision-maker, describe personal values, and make explicit decisions consenting to, or refusing, certain treatments. When a person with a directive refusing life-sustaining treatments attempts suicide, opinions are divided as to the degree to which health care staff are bound by such a directive. In this section, I will provide an example of a patient who presents to hospital after attempting suicide who has a valid ACD refusing life-sustaining treatment. I will then describe the legislation relevant to ACDs in Victoria, Australia and ethical arguments relating to the application of an ACD in this context. I will present a decision-making algorithm for health care staff faced with the difficult decisions arising from such a presentation.
BACKGROUND: Suicide is the leading cause of death in Korean adolescents and it exposes school teachers to the impact of student suicide.
AIMS: This study aimed to explore the bereavement experience of teachers following student suicide.
METHOD: Using semistructured questions, five female teachers working at secondary schools in Korea were interviewed on their bereavement experiences. Data were analyzed using a phenomenological approach.
RESULTS: Participants described their experiences in dimensions of individuals and professions, yielding four major themes and 11 subthemes. They made efforts to learn about the suicide as a first step toward understanding. Participants suspended their grief in public owing to the atmosphere in their workplace. They aimed to tolerate the suicide and recognized their role anew in preventing student suicide.
CONCLUSION: Following student suicide, bereaved teachers experience a variety of effects, dysfunctions, and adjustments as individuals and professionals. Their experience should be understood in both individual and collective ways in school settings and in the cultural context. The findings encourage school health providers to develop programs and policies to help teachers bereaved by student suicide.